J0248 — Injection, remdesivir, 1 mg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Clinical documentation demonstrating effectiveness of the proposed therapy for the relevant diagnosis or procedure.
- For drug therapy, documentation of proposed dose, frequency, and duration and citation of at least one authoritative source (e.g., FDA labeling, MCG, DrugDex, NCCN) supporting the regimen.
- Verify and document the member's benefit plan, summary plan description, or contract terms that apply to the requested service.
- Document any applicable state regulatory requirements that affect coverage.
Key Coverage Criteria
- Requested therapies must be proven effective for the relevant diagnosis or procedure.
- Drug therapies must have proposed dose, frequency, and duration consistent with at least one authoritative source.
- Coverage of an FDA‑approved drug for an off‑label indication when that use is recognized as safe and effective in one or more standard medical reference compendia adopted by the U.S. Department of Health and Human Services.
- Coverage of an FDA‑approved drug for an off‑label indication when safety and efficacy for that use are confirmed by two articles from major peer‑reviewed professional medical journals that present data supporting the proposed off‑label use.
- Treatment of COVID-19 in adults who are hospitalized.
- Treatment of COVID-19 in pediatric individuals (birth to <18 years) who weigh at least 1.5 kg and are hospitalized.
5 Active Policies
BCBSIL-RX501.130 — Remdesivir
BCBSMT-RX501.130 — Remdesivir
BCBSNM-RX501.130 — Remdesivir
BCBSOK-RX501.130 — Remdesivir
RX501.130 — Remdesivir
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